Maternal balanced energy-protein supplementation reshapes the maternal gut microbiome and enhances carbohydrate metabolism in infants: A randomized controlled trial

Balanced energy-protein (BEP) supplementation during pregnancy and lactation can improve birth outcomes and infant growth, with the gut microbiome as a potential mediator. The MISAME-III randomized controlled trial (ClinicalTrial.gov: NCT03533712) assessed the effect of BEP supplementation, provided during pregnancy and the first six months of lactation, on small-for-gestational age prevalence and length-for-age Z-scores at six months in rural Burkina Faso. Nested within MISAME-III, this sub-study examines the impact of BEP supplementation on maternal and infant gut microbiomes and their mediating role in birth outcomes and infant growth. A total of 152 mother-infant dyads (n = 71 intervention, n = 81 control) were included for metagenomic sequencing, with stool samples collected at the second and third trimesters, and at 1–2 and 5–6 months postpartum. BEP supplementation significantly altered maternal gut microbiome diversity, composition, and function, particularly those with immune-modulatory properties. Pathways linked to lipopolysaccharide biosynthesis were depleted and the species Bacteroides fragilis was enriched in BEP-supplemented mothers. Maternal BEP supplementation also accelerated infant microbiome changes and enhanced carbohydrate metabolism. Causal mediation analyses identified specific taxa mediating the effect of BEP on birth outcomes and infant growth. These findings suggest that maternal supplementation modulates gut microbiome composition and influences early-life development in resource-limited settings.

Evolution of intimate partner violence impacts from cash transfers, food transfers, and behaviour change communication: Mixed-method experimental evidence from a nine-year post-programme follow-up in Bangladesh

Cash or food transfers can reduce intimate partner violence (IPV), but knowledge gaps remain on how impacts evolve over time, and the role of complementary ‘plus’ activities and contextual factors. We conducted a mixed-method analysis of how the Transfer Modality Research Initiative in Bangladesh affected IPV over time. The programme was implemented from 2012 to 2014, following a randomised controlled trial (RCT) design, across Northern and Southern Bangladesh. Intervention arms included monthly cash or food transfers, with or without complementary nutrition behaviour change communication (BCC). We estimate post-programme impacts on IPV using quantitative data collected in 2014–2015, 2018, and 2022, and combine this with qualitative data collected in 2023 to explore how and why IPV impacts evolved over time and the role of contextual factors. In the North, combining cash with BCC led to sustained IPV reductions in each post-programme round, while cash alone reduced IPV in 2022 but not the previous two rounds; food transfers showed no post-programme impacts. In the South, combining food with BCC led to post-programme IPV reductions in 2014–2015; no intervention sustained IPV reductions thereafter. Sustained IPV reductions are primarily driven by improved household economic security and emotional well-being. Other pathways – family relationships (including in-laws’ roles), women’s empowerment, and social and community support – contributed to changing couples’ relationships during the programme but became less salient after the programme ended. Contextual factors, including demographic changes, climate-related changes, external projects and norms condoning IPV appear to influence the sustainability of impacts. Results suggest that ‘plus’ programming was key to sustaining IPV impacts soon after the interventions, but less so by nine years post-programme, as economic security increasingly drove impacts. More mixed method research is needed from the outset to unpack if and how pathways to IPV reduction can be sustained in different contexts over time.

Economic and food security impacts of climate disasters and mitigation policies: Insights from Nigeria